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    基于MBISAP评分和PNI、SII的列线图模型对急性胰腺炎患者预后的预测价值

    Predictive value of a nomogram model based on MBISAP score, PNI and SII for the prognosis of acute pancreatitis

    • 摘要: 目的 探讨急性胰腺炎的预后因素,建立列线图模型预测急性胰腺炎患者的生存率。方法 选取2021年2月—2022年5月在徐州医科大学附属医院诊断为急性胰腺炎的398例患者为内部验证组并进行回顾性分析,另外选取150例患者进行外部验证。将内部验证组患者分为死亡组和生存组。采用多因素Logistic回归分析进行预后营养指数(PNI)、全身免疫炎症指数(SII)、改良客观性急性胰腺炎严重程度床边指数评分(MBISAP评分)的列线图构建和校准曲线绘制并进行验证,计算净重新分类指数(NRI)、综合判别改善指数(IDI)评价预测效能。绘制Kaplan-Meier曲线。结果 与生存组相比,死亡组血尿素、中性粒细胞计数、SII评分、MBISAP评分及合并胸腔积液、全身炎症反应综合征(SIRS)的比例均升高(P<0.05),白蛋白、PNI评分降低(P<0.05)。多因素预后分析提示MBISAP、PNI、SII是急性胰腺炎的独立预后因素。列线图模型评分的危险分层提示高危组(总分>67分)患者的28 d病死率更高(P<0.05)。结论 基于MBISAP评分、PNI、SII构建了一个可靠的列线图模型,对急性胰腺炎患者具有较好的预后预测和危险分层价值。

       

      Abstract: Objective To investigate the prognostic factors of acute pancreatitis and establish a nomogram model to predict the survival rate of patients with acute pancreatitis.Methods A total of 398 patients who were diagnosed with acute pancreatitis in the Affiliated Hospital of Xuzhou Medical University from February 2021 to May 2022 were selected as an internal validation group for retrospective analysis, while another 150 patients were selected for external validation. The patients were divided into two groups: a death group and a survival group. The multivariate logistic regression analysis was performed and the prognostic nutrition index(PNI), systematic immunoinflammatory index(SII) and modified bedside index of severity in acute pancreatitis(MBISAP) score were adopted to construct a nomogram model and draw the calibration curve for verification. The net reclassification index(NRI) and the comprehensive discriminant improvement index(IDI) was used to evaluate the predictive efficiency. Kaplan-Meier curves were plotted.Results Compared with the survival group, the death group showed increases in blood urea, neutrophils, SII score, MBISAP score, the number of patients with pleural effusion, and the proportion of SIRS(P<0.05), and decreases in albumin and PNI scores(P<0.05). Multivariate prognostic analysis suggested that MBISAP, PNI and SII were independent prognostic factors of acute pancreatitis. The risk stratification of the nomogram model score suggested that the 28-day fatality rate was higher in the high-risk group(total score >67)(P<0.05).Conclusions Based on MBISAP score, PNI and SII, the reliable nomogram model was constructed, which has good prognostic and risk stratification value for acute pancreatitis patients.

       

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